ICU 患者连续性肾脏替代治疗意外脱机的危险因素：荟萃分析。
Risk factors for unplanned weaning of continuous renal replacement therapy in ICU patients: a meta-analysis.
机构信息
Intensive Care Unit, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan Province, China.
出版信息
Ren Fail. 2024 Dec;46(2):2387431. doi: 10.1080/0886022X.2024.2387431. Epub 2024 Aug 13.
OBJECTIVE
To systematically review the risk factors for unplanned weaning during continuous renal replacement therapy in ICU patients.
METHODS
A combination of subject words + free words was used to search the relevant literature published in CNKI, Wanfang, VIP, CBM, PubMed, EMbase, Web of Science, Cochrane Library, Mediline and other databases. The search period was from the establishment of the databases to June 25, 2024. Revman 5.4 software and Stata15.0 software was used to meta-analyze the risk factors for unplanned weaning during continuous renal replacement therapy in ICU patients.
RESULTS
A total of 23 studies were included in this meta-analysis, describing 15 variables, 3793 patients, and using 7197 filters. Meta-analysis results showed that risk factors for unplanned weaning during continuous renal replacement therapy in ICU patients were as follows: Low mean arterial pressure [OR = 1.02, 95%CI (1.00, 1.03), < 0.05], hypothermia [OR = 3.40, 95%CI (1.78, 6.47), < 0.05], age (≥60 years) [OR = 4.45, 95%CI (3.18, 6.22), < 0.05], comorbid underlying disease [OR = 3.63, 95%CI (2.70, 4.88), < 0.05], agitation [OR = 4.97, 95%CI (3.20, 7.74), < 0.05], no anticoagulant use [OR = 1.65, 95%CI (1.25, 2.17), < 0.05], short activated partial prothrombin time [OR = 1.23, 95%CI (1.13, 1.34), < 0.05], hyper-hematocrit [OR = 1.73, 95%CI (1.13, 2.66), = 0.01], low ionized calcium concentration [OR = 1.48, 95% CI (1.08, 2.02), = 0.01], CRRT that was treated at a high dose [OR = 1.42, 95%CI (1.14, 1.76), < 0.05], mechanical ventilation [OR = 4.25, 95%CI (2.67, 6.77), < 0.05], and lack of dedicated care [OR = 5.08, 95%CI (2.51, 10.28), < 0.05]. However, it is unclear whether platelet count, prothrombin activity, and blood flow velocity are risk factors for unplanned weaning during CRRT in ICU patients, and more studies are needed for further validation.
CONCLUSION
Available evidence suggests that a variety of factors contribute to unplanned weaning of CRRT in ICU patients. Early detection of these risk factors is essential for healthcare professionals to develop preventive and curative strategies.
REGISTRATION
This study is registered on the PROSERO website under registration number CRD42024543554.
目的
系统评价 ICU 患者连续性肾脏替代治疗（CRRT）期间计划性撤机的危险因素。
方法
采用主题词+自由词相结合的方式，检索中国知网、万方、维普、CBM、PubMed、EMbase、Web of Science、Cochrane 图书馆、Mediline 等数据库中关于 ICU 患者 CRRT 期间计划性撤机危险因素的相关文献。检索时间从数据库建立至 2024 年 6 月 25 日。采用 Revman 5.4 软件和 Stata15.0 软件进行 Meta 分析。
结果
共纳入 23 项研究，描述了 15 个变量，3793 例患者，使用了 7197 个滤器。Meta 分析结果显示，ICU 患者 CRRT 期间计划性撤机的危险因素包括：平均动脉压较低[OR=1.02，95%CI（1.00，1.03），<0.05]、低体温[OR=3.40，95%CI（1.78，6.47），<0.05]、年龄（≥60 岁）[OR=4.45，95%CI（3.18，6.22），<0.05]、合并基础疾病[OR=3.63，95%CI（2.70，4.88），<0.05]、躁动[OR=4.97，95%CI（3.20，7.74），<0.05]、未使用抗凝剂[OR=1.65，95%CI（1.25，2.17），<0.05]、活化部分凝血活酶时间较短[OR=1.23，95%CI（1.13，1.34），<0.05]、高血细胞比容[OR=1.73，95%CI（1.13，2.66），=0.01]、低离子钙浓度[OR=1.48，95%CI（1.08，2.02），=0.01]、高剂量 CRRT 治疗[OR=1.42，95%CI（1.14，1.76），<0.05]、机械通气[OR=4.25，95%CI（2.67，6.77），<0.05]和缺乏专人护理[OR=5.08，95%CI（2.51，10.28），<0.05]。然而，血小板计数、凝血酶原活性和血流速度是否为 ICU 患者 CRRT 期间计划性撤机的危险因素尚不清楚，需要更多的研究进一步验证。
结论
现有证据表明，多种因素导致 ICU 患者 CRRT 期间计划性撤机。早期发现这些危险因素对医护人员制定预防和治疗策略至关重要。
注册
本研究在 PROSERO 网站上进行了注册，注册号为 CRD42024543554。
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